How to choose

You walk into the scanning room at 12 weeks’ pregnant, excited to see your baby for the first time. Or perhaps you’re not quite so far along and you’ve come, nerves in knots, hoping to be reassured that the speckles of blood you saw in the toilet bowl are nothing to worry about. Or maybe you’re an old hand now, and you’re here to see if a 6-week heartbeat has turned into a 7-week heartbeat; if those all-important millimetres of growth have materialised. If the bean has turned into a grape; the tadpole into a slightly bigger tadpole.

You ‘hop’ onto the bed (in these situations, they always ask you to hop, or to nip, or to ‘pop’ your clothes off). At first, they do things the way you’d always been told pregnancy scans are done. The only way you knew they could be done. The splat of cold gel on your lower stomach, a persistent push and prod with the probe.

There’s a pause, perhaps a small ‘hmmm’. Perhaps they tell you it’s not always possible to get a good image through the abdomen at this early stage. Or maybe they think your bladder could be too full – or not full enough to get a clear picture. Either way, you ‘pop’ to the loo so they can do an internal scan instead. They never show this part in the movie version: the distinctly dildo-shaped ultrasound wand, covered in a condom, smeared in medical-grade lube.

Another pause. A rummaging sort of discomfort now. Pushing. Probing…… perhaps you feel panic rising, the longer they hold that pause. Or perhaps you just lie there, waiting for them to speak, happy and oblivious – it not having occurred to you yet that the sonographer’s next words might be:

‘I’m sorry, there is no heartbeat.’

This, then, is how they make you choose. While you sit with the blackness of those words, unable to penetrate their meaning – all sense escaping you, like trying to hold smoke in your hands – the medics, the midwives, the sonographers, the private ultrasound clinics, have moved on to new sentences. They want to talk to you about ‘next steps’ and ‘your options’.

‘How would you like to manage this?’ they ask.

Which is a stupid question, because the only answer is you don’t want to manage it all, thank you very much. I would like you to tell me that my baby is alive. Only that doesn’t seem to be an option on any of the leaflets you’ve been given.

This is how they make you choose what to do about your baby, the baby that is still inside of you, only dead.

You are expected to go from ‘I wonder if it’s a boy or a girl’ to ‘surgery, pills or waiting it out: please pick one’ in a matter of minutes.

Perhaps you get to decide in the ‘bad news’ room, with a cup of tea and tissues, if you’re lucky. Or back out in the corridor, surrounded by other pregnant women waiting for their appointments, if you’re not. If you’re naturally a bit bossy – like I am – maybe you insist on going home to decide, to take your time (for the record, you are allowed to do this).

‘I want it out, more than anything. More than anything, I want it to stay.’ – Maggie O’Farrell, I Am, I Am, I Am

Maybe the professionals are kind. Maybe they proffer condolences with the leaflets, direct numbers to helpful people in the right department for once you’ve made up your mind. Or maybe they just look bored, even irritated by your inability to decide. They just want the box ticked.

But how do you make yourself choose? How can you possibly know what you want, or what might be best in the circumstances? As Maggie O’Farrell writes in her memoir I Am, I Am, I Am: ‘I want it out, more than anything. More than anything, I want it to stay.’

I still don’t know how you choose, though I have had to twice now – two of our miscarriages have been so-called missed or ‘silent’ miscarriages. Each time, I wanted so much for someone else to tell me what to do.

But they can’t. Just as I cannot tell you how to choose – if that’s why you find yourself here, or if you ever find yourself in this position in future – not really.

I can tell you the obvious: that surgery makes it definitive, controllable, a time and date you can put in your diary (especially if you can persuade your hospital to put you on an elective list, rather than an emergency one) but it will also involve general anaesthetic and at least a day in hospital. I could tell you that waiting it out could take weeks, but at least you’d be at home and at least you would bear witness to the physical proof of your pregnancy. And I could tell you that pills might be painful, but you get a degree of control and you can be at home, if you wish.

I could also say that surgery gives you the best chance of a clear genetics report if they’ll agree to test your baby for chromosomal abnormalities that might explain the miscarriage. But it’s also not the only option – you can still ask for genetic testing if you choose to wait or manage it with pills. However, you will have to arrange for the ‘tissue’ (their words, not mine) to be collected and brought to the hospital yourself.

The thing is, I know that you will already know all or most of this – and none of it helps, does it?

The only thing I think I can tell you, that I wish someone had told me, is that whatever you choose it won’t feel right. How could it? It is unlike almost any other choice you’ll have made. You won’t get a good gut feeling when you pick one option over another. There isn’t an empirically ‘better’ choice, however much background reading you do. And it is hard to make a pro column when all you see is cons. When the whole thing feels like a con – that you have been cheated out of your baby.

All you can do is take the medical advice they give you, personally. And then balance that with some other reason, which won’t feel like much of a reason at all. If I do X then I can go back to work on Monday and no one needs to know – or we can still go away next week. If we choose Y then we can walk out of here now and not have to come back to the hospital for an operation. If I do Z then I can have my baby at home, and maybe plant their tiny body in my garden.

None of it will feel like a good decision. None of it will feel like consolation.

But this, I think, is how you choose.

Useful resources if you are dealing with a missed miscarriage:

This is a good general summary of the options here, from Tommy’s. They also run a midwife-staffed helpline if you have further questions or just want to talk it over with someone: 0800 014 7800 or you can email them midwife@tommys.org.

And there is some useful information from the NHS here about karyotyping (genetic tests on your baby) and how this can be done, whichever option you choose. Unfortunately, on the NHS genetic tests are often only offered for recurrent miscarriage, so after three or more. But you can always ask.

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17 Comments

Is it weird that I enjoy your posts?!! Not because I’m sadistic, but because you tell it as it is, and every single thing you say sounds like it could be coming out of my own mouth or head. It’s likely it never will come from either of those places because I’d hate to feel like I might make anyone feel uncomfortable. So thanks for voicing my/our feelings so very well, and reminding me when I’m having a feel sorry for myself day, I’m not in this weird little sh*tty club all on my little own, and to accept some days will be more sh*tty than others.

Hi Rachel – I for one don’t think it’s weird at all, and I’m so glad you’re reading and getting something out of my posts. Though obviously I wish you didn’t need to be here at all. We’re definitely not alone in this and I’m always so glad to have such lovely people here with me (even if it’s just in these little corners of the internet). Jennie xxx

I think it takes a while to be able to talk about it more openly – three was something of a threshold for me, too. So glad to have you here, even though I wish none of us had to be in this terrible club! Jennie xxx

Such a good post that totally sums up how it feels to be presented with these options. And even when you pick the ‘right’ option for you, you might still not have the outcome you expected. Having been told that waiting it out/medical management could mean surgery in the end anyway if everything didn’t come out on it’s own, I opted for surgery straight away. Two weeks after surgery I started bleeding heavily and following some very frustrating and upsetting back and forth with my GP and a Gynaecologist (‘It’s probably your period coming back’ grrr) I was finally scanned again at the EPU, where ‘retained vascular tissue’ was found. And guess what? You’re right back in the same room with an obstetrician being given the same three, throughly unnappealing options. My second miscarriage happened naturally and at the time I was actually able to feel some relief that, even though we’d lost another baby, I didn’t have to have more surgery.

This is such a good point – I didn’t go into it in the post for space reasons, but this was one of the factors I’ve opted for surgery both times, too. I was quite frightened of the surgical option, but figured that Sod’s law would be I’d end up needing it anyway. It’s presented as a straightforward choice, but your control of the situation isn’t completely watertight, as you say. There are so many factors and ‘what ifs’, that it’s an awful lot to get your head around in what can be a very short space of time. I’m so sorry this extra, shitty complication happened to you. It feels so unfair when all you want – if it has to be over – is for it really to be over. Thank you so much for reading. Jennie xxx

Thank you for your honest and open writing. I have just had a second miscarriage. This time it was a MMC and I went for the surgical option too as I wanted it all to be over. They say to wait three months before trying again and it feels like such a long time. Did you have the testing after three? Did you go with the NHS or did you go private? I’m unsure of next steps and don’t know whether to get testing now privately rather than waiting to see if this happens again- even though it is very expensive. Any advice would be greatly appreciated.

I’m so sorry you’re going through this. We had tests after three, yes. We went through the NHS as paying privately just wasn’t an option at the time. We were seen at St Mary’s in London and they did a scan to look at the structure of my uterus and lots of different blood clotting tests. Strictly speaking, on the NHS I think most places will only refer you for investigations after three miscarriages (such a horrible feeling after two, I remember, as you’re desperate for answers but ineligible for tests) – however, I have heard of some GPs being kind and wangling a referral after two, so it may be worth asking. If you’re unsure/unable to go private, consider googling the miscarriage clinic in Warwick and the work being done by Professor Quenby there. It’s run out of an NHS hospital – University Hospital in Coventry – but because it contributes to research/what they’re looking at is fairly new science, they charge a fee (but it’s a lot less than what you might pay at a private clinic). They see patients from all over with a GP referral – and I don’t think you need to wait until three. They do tests looking at the way the uterus lining is behaving. I wrote a couple of posts a while back about the testing process, here: https://uterusmonologues.com/2017/12/06/testing-times-miscarriage-clinic/ and here: https://uterusmonologues.com/2018/02/19/no-news-is-good-news/ Just in case they’re useful to you. Sending love. And please know it does get better. Jennie xxxx

Thank you for the advice. I have asked to be referred to the Tommy’s clinic in Birmingham as you can be referred there after two. I have been to my GP and she says she has referred people after two before on the NHS and they have been rejected so I think this is my only option without having to pay. I have got an appointment coming for a scan arranged by my GP and they are doing some blood tests too. I think I am just being impatient as I know the wait for the Tommy’s referral will be a long process. It seems unfair that we have to go through so much to be seen by someone on the NHS. I will look into the clinic in Warwick too thank you for the information. I have read quite a few of your posts tonight and they have really helped me so thank you.